Nevenka Krčevski Škvarč1, Bart Morlion2, Kevin E Vowles3, Kirsty Bannister4, Eric Buchsner5, Roberto Casale6, Jean-François Chenot7, Gillian Chumbley8, Asbjørn Mohr Drewes9, Geert Dom10, Liisa Jutila11, Tony O'Brien12, Esther Pogatzki-Zahn13, Martin Rakusa14, Carmen Suarez-Serrano15, Thomas Tölle16, Winfried Häuser17,18. 1. Department of Anesthesiology, Intensive Care and Pain Treatment, Faculty of Medicine of University Maribor, Maribor, Slovenia. 2. Center for Algology & Pain Management, University Hospitals Leuven, Leuven, Belgium. 3. School of Psychology, Queen's University Belfast, Belfast, UK. 4. Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. 5. Pain Management and Neuromodulation Centre EHC Hospital, Morges, Switzerland. 6. Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy. 7. Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany. 8. Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK. 9. Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Aalborg, Denmark. 10. Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium. 11. Pain Alliance Europe, Finland. 12. College of Medicine & Health, University College Cork, Cork, Republic of Ireland. 13. Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster UKM, Munster, Germany. 14. Department of Neurology, University Medical Centre Maribor, Maribor, Slovenia. 15. Department of Physiotherapy, University of Sevilla, Sevilla, Spain. 16. Department of Neurology, Techhnische Universität München, München, Germany. 17. Department Internal Medicine 1, Saarbrücken, Germany. 18. Department of Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany.
Abstract
BACKGROUND: Opioid use for chronic non-cancer pain (CNCP) is under debate. In the absence of pan-European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC). METHODS: The clinical practice recommendations were developed by eight scientific societies and one patient self-help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence-based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case-series, case-control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment. RESULTS: The European Clinical Practice Recommendations give guidance for combination with other medications, the management of frequent (e.g. nausea, constipation) and rare (e.g. hyperalgesia) side effects, for special clinical populations (e.g. children and adolescents, pregnancy) and for special situations (e.g. liver cirrhosis). CONCLUSION: If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. SIGNIFICANCE: If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. A collaboration of medical specialties and of all health care professionals is needed for some special populations and clinical situations.
BACKGROUND: Opioid use for chronic non-cancer pain (CNCP) is under debate. In the absence of pan-European guidance on this issue, a position paper was commissioned by the European Pain Federation (EFIC). METHODS: The clinical practice recommendations were developed by eight scientific societies and one patient self-help organization under the coordination of EFIC. A systematic literature search in MEDLINE (up until January 2020) was performed. Two categories of guidance are given: Evidence-based recommendations (supported by evidence from systematic reviews of randomized controlled trials or of observational studies) and Good Clinical Practice (GCP) statements (supported either by indirect evidence or by case-series, case-control studies and clinical experience). The GRADE system was applied to move from evidence to recommendations. The recommendations and GCP statements were developed by a multiprofessional task force (including nursing, service users, physicians, physiotherapy and psychology) and formal multistep procedures to reach a set of consensus recommendations. The clinical practice recommendations were reviewed by five external reviewers from North America and Europe and were also posted for public comment. RESULTS: The European Clinical Practice Recommendations give guidance for combination with other medications, the management of frequent (e.g. nausea, constipation) and rare (e.g. hyperalgesia) side effects, for special clinical populations (e.g. children and adolescents, pregnancy) and for special situations (e.g. liver cirrhosis). CONCLUSION: If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. SIGNIFICANCE: If a trial with opioids for chronic noncancer pain is conducted, detailed knowledge and experience are needed to adapt the opioid treatment to a special patient group and/or clinical situation and to manage side effects effectively. A collaboration of medical specialties and of all health care professionals is needed for some special populations and clinical situations.
Authors: Patrice Forget; Champika Patullo; Duncan Hill; Atul Ambekar; Alex Baldacchino; Juan Cata; Sean Chetty; Felicia J Cox; Hans D de Boer; Kieran Dinwoodie; Geert Dom; Christopher Eccleston; Brona Fullen; Liisa Jutila; Roger D Knaggs; Patricia Lavand'homme; Nicholas Levy; Dileep N Lobo; Esther Pogatzki-Zahn; Norbert Scherbaum; Blair H Smith; Joop van Griensven; Steve Gilbert Journal: BMC Health Serv Res Date: 2022-03-12 Impact factor: 2.655